Femoral-Tibial Bypass Surgery for Peripheral Arterial Disease

Surgery Overview

To bypass the narrowed or blocked blood vessel, blood is
redirected through a healthy blood vessel that has been transplanted or through
a man-made graft material. This vessel or graft is sewn above and below the
diseased artery so that blood flows through the new vessel or graft. Before
surgery, the doctor determines what type of material is best suited to bypass
the blood vessel.

Whenever possible, the surgeon will choose to
use an existing piece of vein taken from either leg. Man-made graft materials
(such as polytetrafluoroethylene [PTFE] or Dacron) are more likely to become
narrowed again. But they may still be effective and are used when a vein is not
available.

The section of vein or man-made blood vessel is sewn
onto the small vessels of the lower leg or foot so that blood can travel
through the new graft vessel and around the diseased area.

General anesthesia
or an injection in the spine (epidural) is used for this surgery. General
anesthesia will cause you to sleep through the procedure. An epidural prevents
pain in the lower part of the body.

What To Expect After Surgery

You may need
to stay in the hospital for 3 to 5 days.

You will have some pain from the cuts (incisions) the doctor made. The pain usually gets better after about 1 week. Your doctor will give you pain medicine. You can expect your leg to be swollen at first. This is a normal part of recovery and may last 2 or 3 months.

You will need to take it easy for 2 to 6 weeks at home. It may take 6 to 12 weeks to fully recover.
You will probably need to take at least 2 to 6 weeks off from work. It depends on the type of work you do and how you feel.

You will need to have regular checkups with your doctor to make sure the graft is working.

Why It Is Done

This surgery is used for people who
have narrowed or blocked tibial or peroneal arteries, which are near the
surface of the legs. Most of the time, people also have narrowed or blocked femoral and
popliteal arteries too. Usually, a person has severe symptoms
or the problem is limb-threatening before bypass surgery is considered.

Hirsch AT, et al. (2006). ACC/AHA 2005 practice
guidelines for the management of patients with peripheral arterial disease
(lower extremity, renal, mesenteric, and abdominal aortic): A collaborative
report from the American Association for Vascular Surgery/Society for Vascular
Surgery, Society for Cardiovascular Angiography and Interventions, Society for
Vascular Medicine and Biology, Society of Interventional Radiology, and the
ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop
Guidelines for the Management of Patients With Peripheral Arterial Disease):
Endorsed by the American Association of Cardiovascular and Pulmonary
Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular
Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease
Foundation. Circulation, 113(11): e463–e654.

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